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GI P2a > Resp > Flashcards

Resp Flashcards

1
Q

What are the common organisms of community acquired pneumonia?

A

Streptococcus pneumoniae (gram pos), H.influenzae (gram neg coccobacillus), mycoplasmum pneumoniae (rod, acid fast stain)

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2
Q

What is a common cause of pneumonia in immunocompromised patients?

A

pneumocystitis jiroveci

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3
Q

Whats the treatment for s.pneumoniae?

A

amoxicillin

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4
Q

What is the treatment for m.pneumoniae?

A

erythromycin

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5
Q

what’s the tx for chlamydia pneumoniae?

A

erythromycin

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6
Q

what is the tx for legionella spp.?

A

clarithromycin

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7
Q

What is the difference between restrictive and obstruction lung disease?

A
  • FEV1/FVC = <0.7 in obstructive
  • obstructive: airway related
  • restrictive: parenchyma and pleura related
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8
Q

What is the pattern in flow loop seen in asthma and other obstructive diseases?

A

scalloping

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9
Q

What gene mutation causes A1A1 deficiency?

A

SERPEINA 1

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10
Q

What is a A-A gradient and what is it useful for?

A

alveolar-arterial gradient. Can help narrow down causes of hypoxia.

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11
Q

What are the causes of type 1 resp failure? (there are 3 categories)

A
  1. low O2 delievery (eg, altitude: high altitude pulmonary oedema)
  2. gas exchange/diffusion limitation (ILD and asbestosis)
  3. ventilation/perfusion mismatching (pneumonia, PE, pulmonary HTN)
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12
Q

What are the causes of type 2 resp failure?

A
  1. obstruction (asthma and COPD)

2. alevolar hypotension (emphysema, MND, mscular weakness, reduced medulla resp drive, obesity)

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13
Q

What is acute coryza? what virus causes it?

A

Permanent dilation of airways. caused by rhinovirus

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14
Q

What is the Geneva score used for?

A

Predicting the probability of PE

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15
Q

What is the difference in treatment of haemodynamically stable and unstable PE patients?

A
  • Stable: apixaban with CTPA (CT pulmonary angiogram)

- instable: alteplase

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16
Q

What are the varying underlying pathology of the two types of COPD?

A
  • Pink puffer: emphysema. Hyperventilation prevents hypoxia
  • Blue bloaters: chronic bronchitis. Respond to increased obstructions by decreasing ventilation and increasing cardiac output. :eads to hypoxia
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17
Q

What is the aetiology of TB?

A

mycobacterium tuberculosis

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18
Q

How is TB Dx?

A

Latent: Mantoux test.
Active/miliary: CXR- pleural effusion. Patchy/nodular shadows. Sputum smear for acid fast bacilli. NAAT (PCR) can detect drug resistance

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19
Q

How is TB treated?

A

4 for 2 and then 2 for 4 (6 months)

isonizid, rifampricin, pyrazinamide, ethambutol

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20
Q

What cells are involved in asthma?

A

Eosinophils, IgE produced. Hypersensitvity reaction

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21
Q

What is the treatment cascade for asthma?

A

SABA (B2 agonist) –> corticosteroids –> LABA –> increased dose of corticosteroids –> prednisolone –> hospital

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22
Q

What sPO2 defines asthma as life threatening?

A

<92%

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23
Q

What are the different PEFRs for asthma classes?

A
  • uncontrolled: >50%
  • severe: 35-50%
  • life threatening: <33%
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24
Q

Where is most affected with idiopathic pulmonary fibrosis?

A

periphery and base. This is where crackles will be heard

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25
Q

What is the pathophysiology of IPF?

A

patchy fibrosis of interstitium, minimal or absent inflammation. Fibroblasts resistant to apoptosis. Proliferate and form fibroblastic foci. Thickened tissue: less gas exchange in lungs. Leads to honey comb lungs

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26
Q

What is the tx for IPF?

A
  • pirfenidone (reduces fibroblast damage)

- nintedanib (inhibits tyrosine kinase). Neither cure, but reduce FVC rate of decline

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27
Q

What is extrinsic allergic alveolitis?

A

Form of ILD. Inflammatory type III hypersensitivity reaction. IgG deposits in the lung

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28
Q

What lung cancer is most strongly associated with asbestos?

A

Non small cell adenoma and mesothelioma

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29
Q

What lung cancer is most common in non smokers?

A

Non small cell adenoma –> adenocarcinoma

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30
Q

what is the gold standard dx for mesothelioma?

A

pleural biopsy

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31
Q

What’s the difference between transudate and exudate in pleural effusion?

A
  • transudate: <30g/L of protein. Due to change in systemic conditions (increased hydrostatic or decreased osmotic)
  • exudate: >30g/l of protein. Due to cellular elements that ooze out of blood vessels due to inflammation or local damage. increased permeability of pleural surface and capillaries due to inflammation
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32
Q

What are the causes of a transudate pleural effusion?

A

heart failure, cirrhosis, hypoalbuminaemia

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33
Q

What are the causes of exudate pleural effusion?

A

cancer, pneumonia, autoimmune conditions, post cardiac surgery Dressler syndrome

34
Q

What is sarcoidosis?

A

multisystem chronic inflammatory condition. Formation of non caseating epitheliod granulomata (aggregation of macrophages as a result of inflammation). Form of ILD. Normally an incidental finding.

35
Q

What is CURB 65:

A
  • used for scoring severity of pneumonia:
    1. confusion
    2. urea (>7mmol/L)
    3. resp rate (>30/min)
    4. BP <90/60 mmHg
36
Q

What is antigenic drift?

A

gene mutation leading to flu being able to reinfect people every year

37
Q

what is antigenic shift?

A

2 strains of flu combining to form a new strain

38
Q

in portal hypertension, what are the investigations and findings?

A
  • CXR: enlarged pulmonary arteries

- ECG: ventricular hypertrophy

39
Q

what antibodies are cirulating in Good Pasture’s syndrome?

A

against the basement membrane of both the glomerulus and lung. Thus can also cause AKI injury due to nephritic syndrome.

40
Q

What is the commonest cause of infective exacerbation of COPD?

A

haemophilus influenza

41
Q

What is the 1st line investigation in a COPD flare up?

A

ABG

42
Q

What asthma tx can be associated with a fine tremor?

A

SABA

43
Q

What do each of the CURB 65 scores indicate

A
  • 1 or 0: treat as outpatient
  • 2: inpatient
  • 3: inpatient ICU
44
Q

What can cause polycythaemia? What other compx ca this aetiology have?

A

prolonged hypoxia. This can also lead to pulmonary hypertension (due to reactive pulmonary vasoconstriction)

45
Q

What causes early onset COPD, with no smoking?

A

A1AT deficiency

46
Q

What two systems have symptoms in A1AT def?

A

liver and lungs

47
Q

What are the following a typical presentation of?Dry cough, dyspnoea, bibasal crackles

A

IPF

48
Q

What is the gold standard dx for IPF? what is shown?

A

High res CT. ground glass apperance

49
Q

What is the dx for EAA?

A

bronchoalveolar lavage. show increased mast cells, and evidence of type III hypersensitivity reaction

50
Q

What acronym is associated with granulomatosis w/ polyangitiis?

A

ELK! these are the areas affected. ENT, lung, kidney

51
Q

How is good pastures diagnosed?

A

lung and kidney biopsy

52
Q

What ICS is used in asthma?

A

beclametasone.

53
Q

what LTRA is used in asthma? When must it be taken?

A

montelukast. Must be taken at night

54
Q

What LABA is used in asthma?

A

salmeletrol

55
Q

What LAMA is used in asthma?

A

Titropium

56
Q

How do you diagnose TB (like which stain, etc)

A

Acid fast bacilli will stain red/pink w/ Ziehl Neelsen stain

57
Q

What triad is typical of TB?

A

weightloss, low grade fever, night sweats

58
Q

How does TB appear on a xray?

A

fibronodular opacities on upper nodes

59
Q

What are the side effects of each of the TB Abx?

A

R: rifampicin: red urine
I: isoniazid: neuropathy
P: gout/ hepatitis
E: ethambutol: optic issues

60
Q

how can you quickly differentiate pneumonia from TB?

A

far shorter Hx!

61
Q

What is the characteristic symptom of s.pneumoniae?

A

rusty red sputum

62
Q

What is the wells score?

A

Severity of PE

63
Q

How long does a patient need to take thrombolytic medication after event?

A
  • provoked: 3 months

- unprovoked: >3 months

64
Q

What causes pulmonary hypertension?

A

anything that increases pulmonary vascular resistance or pulmonary blood flow

65
Q

What can be heard with pulmonary HTN?

A

tricuspid regurg murmur

66
Q

What is diagnostic for pulmonary HTN?

A

right heart catheterisation

67
Q

What size of pneumothorax is the point where needle aspiration occurs? What other factor affects tx?

A
  • 2cm

- always needle aspitation if short of breath

68
Q

What does the trachea do in pneumothorax?

A

deviates to the opposite side

69
Q

What size, gender and age are most likely to have a spontatenous pneumothorax?

A

young, male, low BMI

70
Q

What is the most common lung cancer?

A

squamous cell carcinoma

71
Q

What is the best treatment for penicillin allergic severe pneumonia?

A

levofloxacin

72
Q

Where should a large bore be inserted in a tension pneumothorax?

A

2nd IC space, midclavicular line

73
Q

What is a mneomnic for remember the criteria for life threatening asthma?

A

33 92 CHEST

  • 33: PEFR <33%
  • 92: pulse oximetry below 92%
  • cyanosis
  • H: hypotension
  • E: exhausation
  • S: silent chest
  • tachycardia
74
Q

What is classic presentation of epiglottitis, and what is a common cause (and why has incidence decreased)

A
  • fever, upright sitting position and drooling

- caused by haemophilus influenza. Decreased due to vaccination

75
Q

What bacteria can be detected via a urine test?

A

Legionella.

76
Q

What is a common ECG presentation of PE

A

sinus tachycardia

77
Q

What is a key finding with sarcoidosis?

A

hypercalcaemia

78
Q

What condition presents with tramline opacities and ring shadows on CXR?

A

bronchiectasis

79
Q

What are the classic signs and symptoms of granulomatous with polyangiitis?

A
  • Classic sign on exams: saddle shaped nose
  • Epistaxis
  • Crusty nasal/ ear secretions 🡪 hearing loss
  • Sinusitis
  • Cough, wheeze, haemoptysis
80
Q

What is the action of ipratropium and atropine?

A
  • muscarinic ACh receptor antagonist

- also acts as a bronchodilator

GI P2a (12 decks)

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